177995 10/13/2009 CITY OF CARMEL, INDIANA VENDOR: 363397 Page 1 of 1
ONE CIVIC SQUARE JOSEPH GRIFFITHS CHECK AMOUNT: $889.20
CARMEL, INDIANA 46032 12906 DOUBLE EAGLE DRIVE
CARMEL IN 46033
CHECK NUMBER: 177995
CHECK DATE: 1 011 312 009
D EPARTMENT ACCO PO NUMBER INVOICE NUMBER AMOU DESCRIPTION
1401 4343004 632.90 IACT P'ERDIEM /HOTEL
1401 4343004 256.30 MILEAGE
PA1004KF. VILLAGE. L Ib
7900 li. CR 1025 S.
FREW LID, IN V132
12-9,G 9054
Sale
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lot u:l:
C,1.3tomcr copy
THANK YOU'
COME AGAIN!
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888- 324 -5350 S�
The PINES at ka,, LLake Village (812) 936 -9854
INQUIRY /RESERVATION rending ®c >z ea
Arr. Day/ Date G�� 1 AUK Time
Dep. Day Date -a lM_ 1 19 eO Time
Nights Cabins 7 Adults Children
Name
Address
City d
lip
F I
Home Phone n
19 Work Phone
Rate Charges /Credits /Amt. Due: DEPOSITS
A Base- Rate (2 persons) Damage dep. /AVAIL REC'D
B Extra Adults x $10.00.
C (Children under 7 free) How: Date:
D t�a TTL •Night (A B C) ❑Rental deposit recd.
E TTL Visit (D x nights) How: Date:
Discount (if any)
G .�9�� �TTL subject to tax (E F) Card No
H Vg? S VTax ()0% of line G) Ex. Date 015 aD
1 1 1 9.9 TTL Charges G H
g J�}' Name
J '�"�"Rental Deposit�fQ���`�°'
K TTL Amt. due (I J) E:] Refund required
L L WA Amt. Paid on arrival UiS-9 Amount
M Balance Due (K L)
Date Mailed
Introduced by: Rec'd by:
,Phone Visit El Letter El RC &-D` Date d
n Brochure mailed Date 36rifirmation mailed Date 9 �--d
Comments: Cabin. No.
Bring bath towels and bath soap.-
Reservation subject to $25.00 cancellation fee.
i
RESERVATIONS CANCELLED AT LEAST 14 DAYS PRIOR TO
ARRIVAL DATE WILL HAVE DEPOSIT REFUNDED.
Prescribed by State Board of,Accounts City Form No. 201 (Rev, 1995)
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice or bill to be properly itemized must show: kind of service, where performed, dates service rendered, by
whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc.
Payee
qS Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or
rK
1-
5D
Total 3a U
1 hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and I have audited same in accordance
with IC 5- 11- 10 -1.6.
20
Clerk- Treasurer
VOUCHER NO. WARRANT NO.
ALLOWED 20
IN SUM OF
I l
ON ACCOUNT OF APPROPRIATION FOR
Board Members
PO# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
bill(s) is (are) true and correct and that the
materials or services itemized thereon for
which charge is made were ordered and
received except
t� r 20
y
Signatur
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
DATE STARTING MILEAGE ENDING MILEAGE DIFFE CE
1014109 35968 ]ACT CONFERENCE IN FRENCH LICK
1 61-71 -0 36434 466 IACT CONFERENCE IN FRENCH LICK
LEE
%29 06 J 4 ,�a y le
6a rm e .s
J
Prescribed by State Board of Accounts General Form No- 101 (1955)
MILEAGE CLAIM"
TO DR.
(Governmental Unit
On Account of Appropriation No. for
(Office, Bprd, Department or Institution)
DATE FROM TO ODOMETER READING` NATURE OF BUSINESS AUTO MILES MILEAGE
2 Point Point Start Finish TRAVELED PER MILE
i
Auto License No. TOTALS
I
SPEEDOMETER READING columns are to be used only when distance between points cannot be determined by fixed mileage or official highway map.
I
Pursuant to the provisions and penalties of Chapter 155, Acts 1953, 1 hereby certify that the foregoing account is just and correct, that the amount claimed is legally due, after
allowing all just credits, and that no part of the same has been paid.
Date i
i
Claire No. Warrant No. I have examined the within claim and
hereby certify as follows:
IN AVOR OF
Or That it is in proper form;
J�� jv That it is duly uthentic required
y ated as quit
by law;
That it is based upon statutory authority; correct
That it is apparently f incorrect
T
On Account of Appropriation No.
Disbursing Officer
C QA
Allowed 20
4c
in the sum of O
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S n (D
(D
(D
ID
8
G
(D
N (D Q
(Bcscad or Cornrnission) la O
M
(D (D
FILED m Q
i ro
o N
Q
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r (D
(Official Title)
D O
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